The pharmacist-as-coach

Out of the drugstore, into the community

"None of us will change," says the Illinois Pharmacists Association's Starlin Haydon-Greatting, "unless we hit a brick wall."

In 2005, Chicago joined nine other cities in a battle to change the way diabetes is treated. The goal was to help diabetics improve their health and avoid nasty complications such as heart disease, blindness and amputations. In doing so, the cities hoped to reduce the cost of treating the disease, which in 2007 accounted for more than 5 percent of all health care spending.

They turned to community pharmacists, who agreed to step in and provide one-on-one coaching to diabetics, especially those who were struggling to follow doctor's recommendations for diet, exercise and medication. The Midwest Business Group on Health spearheaded the effort in Cook County, where nearly 9 percent of adults suffer from the disease.

Working with the Illinois Pharmacists Association, the Midwest Business Group on Health recruited a few big employers such as Hospira Inc. and Pactiv Inc. to participate in the “Taking Control of Your Health” program. Participating companies offered to waive or reduce employees' co-pays for drugs and glucose test strips if they agreed to meet with a pharmacist coach four times a year. (A couple of years later, the city of Chicago offered some employees access to the program on a voluntary basis.)

Now the Midwest Business Group on Health and the Illinois Pharmacists Association are gearing up to expand the program to other costly chronic conditions including depression, asthma and heart disease. The approach will be the same: To provide education and encouragement outside the workplace as the employees adjust to treatments and life-style changes. The aim is to help patients overcome their ambivalence about engaging in healthy behavior. “None of us will change . . . unless we hit a brick wall. Our job is . . . to move that brick wall closer to them,” says Starlin Haydon-Greatting, a registered pharmacist and clinical program coordinator for the IPhA. Ms. Haydon-Greatting is also one of the roughly 400 pharmacists in Illinois who have been specially trained to do this work.

STILL PRICEY

In the case of diabetics, the national program proved to be a success: Within 12 months, rates of uncontrolled diabetes decreased, as did measures of heart disease. And on a per-patient basis, health care spending for employees in the program was $1,079 (or 7.2 percent) less than projected costs for uncoached patients. “People are not in the hospital emergency rooms, they are not having unnecessary hospital stays, and they are seeing their doctors for monitoring—not just for serious complications,” says Larry Boress, MBGH's president and CEO.

The program isn't cheap. With educational programming and pharmacists' visits, it now costs employers about $600 per patient, says Margaret Rehayem, MBGH's director of member initiatives. “It's a commitment,” she says. (Employer costs were subsidized by grants in the first few years of the program.)

The upfront costs are significant and might be a turnoff to employers. And while the costs might limit the number of payers willing to sign on, proponents say there is a potential for downstream savings, especially if a pharmacist's review helps to sidestep adverse drug reactions.

“The cost of drug-related morbidity and mortality is far more than what you are going to pay the pharmacist to fix the problem,” says Brian Isetts, a health fellow at the Center for Medicare and Medicaid Innovation in Baltimore. More than 10 years ago, Mr. Issets helped establish such a program for Fairview Health Services, a network that includes hospitals, clinics and home care services in Minnesota.

Their medication management program integrates the pharmacists into medical clinics and has been a boon to doctors, says David Moen, Fairview's medical director of care model innovation. Developing a plan that takes into account various combinations of medicine “is just something physicians don't spend time on and aren't really trained to do,” Dr. Moen says.

MGBH expects interest to rise as the groups produce trend data showing cost savings, including through increased productivity and reduced absenteeism. “We are working on quantifying it,” Ms. Rehayem says.

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A program coaching patients to be healthier produces some encouraging results.